Provider Demographics
NPI:1720787443
Name:MONTIEL, ELIZABETH MARIA (FNP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MARIA
Last Name:MONTIEL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2320 CHATEAU WAY
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550-5709
Mailing Address - Country:US
Mailing Address - Phone:510-575-4640
Mailing Address - Fax:
Practice Address - Street 1:2320 CHATEAU WAY
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-5709
Practice Address - Country:US
Practice Address - Phone:510-575-4640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-02
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95024435363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily